Luckily medicine has advanced a lot and, luckily also, more and more children who are born before their date are coming forward, but we must not forget that the incidence of prematurity in Spain is 7-10% in all newborns born. About how is the care and care of premature babies We have spoken with Two Pediatricians at Home.
'The premature child always requires special care that is focused on giving him everything that he has not been able to do inside the mother's gut. Being born a few months before or a few weeks before the due date means that the baby has not fully matured and that, therefore, that maturation that he lacks for having come to this world before his time has to be carried out in an environment other than his mother's womb. '
But before delving into what attention and care do premature babies need, it is necessary to know the degree of prematurity of each child. "The child born at 23 weeks, who is a very premature baby and will weigh around half a kilo, is not the same as the one who arrives in this world in the 34th week of pregnancy and who can already weigh almost two kilos." A child is considered premature when it is born before the 37th week of pregnancy.
‘To point out, in addition, that the more premature a child is, the more likely they are to present complications. For example, below week 26 of gestation, the probability of being a healthy child without problems at any level is 10% and among these complications, neurological disability is the most important since it is the one that can most affect measure the lives of these children when they grow up. In fact, when a situation of premature birth occurs and the pediatricians go to talk to the parents, the first thing they ask us is the chances that this little one has to survive. What we tell you is that the probability is 30-40% when delivery occurs before week 26, but disease-free survival is very poor. However, mortality improves much above week 28, with 9 out of 10 children surviving. '
Hence it is of great importance extreme care and attention for premature babies since they leave mommy's belly. 'We have to try that the exterior is the closest thing to staying inside the mother's womb: in the dark, without noise, warm, with humidity, minimum possible manipulations ... And that is what is tried in the Intensive Care Units Neonatal with these children. In addition, parents are encouraged to perform the kangaroo method, that is, to be skin-to-skin with the mother or father for at least two hours a day outside the incubator, because it has been shown that this favors the stability of the children and their neurological development. '
A pregnancy control reduces the risk of premature birth and, therefore, of having a premature baby, that is why it is important to take care of yourself (diet, exercise ...) and go to each of the appointments with the midwife and / or gynecologist . But if, even so, everything is triggered earlier than expected and expected, gynecologists can administer corticosteroids to the woman: a medication that makes the premature baby's lungs mature, which substantially improves her prognosis.
'When there is a threat of premature labor, one of the objectives of gynecologists is to stop the situation so that the baby is not born instantly and the mother receives a course of corticosteroids for 48 hours. This has been shown to improve both the lung function and the neurological sequelae of the child. It is a protocol of good clinical practice that is carried out in all hospitals in the world. '
'The late preterm, those born between 34 and 37 weeks, is a group of premature infants who, until a few years ago, had received little attention from neonatologists, in part because they are born mature enough not to present problems as soon as they are born: they weigh more than 2 kilos, eat alone and do not usually need respiratory support. However, in the long run these children have been found to have more learning difficulties or hyperactivity than a full-term child. '
'It is important to follow your case closely so that you can act on time if necessary. The neurological problems of these children cannot be prevented since they are conditioned but the fact of having been born prematurely, that is, what has already happened has already passed, but their functionality can be improved by doing early treatments.
The baby that comes out of its mother's gut early often has problems at different levels, both at birth and once they have been discharged. It is, as Two Pediatricians at Home say, a set of circumstances that must be treated during their admission and later in the pediatrician's office.
- Respiratory problems
This is the main problem when the child is born, since the first thing the baby has to do to survive is breathe and the lungs of premature babies are immature. Hence, in many cases, the child needs, depending on the severity, additional oxygen or other more invasive types of respiratory support.
- Digestive complications
As with the lungs, the intestine of premature babies is also immature. On the one hand, oral feeding (both with breast milk and artificial) in large quantities can overload your intestine and run the risk of suffering from necrotizing enterocolitis, although the first one protects against this fact. It should also be noted that, until week 34, there is no coordination between sucking and swallowing, which means that these children are fed through a nasogastric tube until they are able to do it themselves.
- Neurological disorders
Without a doubt, they will be the ones that will most affect the future life of a premature baby and its degree of independence. These occur for several reasons, but the main one is because the brain of premature infants must mature and develop outside of where it was designed to do so: the mother's womb. To try to reduce these neurological problems, so-called Developmental Care is carried out during admission, such as taking care of the baby's postures in the incubator and favoring skin-to-skin. Once these children are discharged, it is very important that they go to the pediatrician's office so that they can monitor their development and refer them to early care as soon as possible if necessary.
- Anemia in premature babies
It is very common in this type of children and can have consequences for their development, hence, in some cases, blood transfusions are performed during hospitalization. At discharge, these children should receive oral iron until they start complementary feeding.
'At discharge, after the neurological sequelae, the most important are respiratory complications since they are born with an immature lung. They are children who have a higher risk of suffering from bronchiolitis and that it is serious. In children with sequelae it is very important that they receive early attention for language development and psychomotor development, 'they explain.
'In addition, throughout the childhood of these children we must carry out a personalized follow-up from the Health Center with their check-ups and with their vaccines, and that is where we try to detect if the neurological development is adequate or there is a problem or delay. It is important to know that premature infants may take a little longer than normal to reach milestones in psychomotor development. This is where the corrected age plays an important role. For example, a premature baby who was born two months early is very likely to be two months behind in psychomotor development in non-premature children of the same age, without this being considered pathological. '
And what about the issue of vaccines? 'Vaccines in premature babies are set at chronological age and are usually administered in the neonatal unit, because many of them remain hospitalized at the time of having to receive them. They are the same vaccines that non-premature babies receive and, in some cases, an extra dose of one in particular is recommended. For example, pneumococcus is known to need a boost, 'they explain.
'For the smallest premature babies, there is' the bronchiolitis vaccine'. It is not really a vaccine even though it is called that. What this ‘vaccine’ does is directly put the antibodies that generate protection against the virus that causes bronchiolitis: RSV or respiratory syncytial virus. It is recommended, in turn, to use it throughout the bronchiolitis epidemic, generally between October and March. '
After the birth of a premature baby, in the vast majority of cases, the mother is aware of the important role that she plays in this situation and that is why she wants to carry out the 'skin to skin' so necessary for both parties.
'However, what happens is that many times, due to the immaturity of the premature baby and the needs of resuscitation after delivery, it is not possible. 'What is usually done, for example, in late preterm infants who are stable but meet entry criteria, is to put the infant on the mother's breast or delay cord clamping (as long as the infant does not need resuscitation) to try that it also benefits from the skin-to-skin practice that we would do in a full-term baby. Of course, we must anticipate any situation as professionals, informing parents of the protocol and guidelines to follow in these conditions. '
'In all children it is important but, in the case of premature babies, breastfeeding is more important if possible and, although the mother's milk has not risen in the first days, colostrum has a vital function. If the mother wants, at the hospital the midwife will help her to do the manual extraction, to put the colostrum into the baby's mouth, which will be like his first vaccine by providing immunological protection from the first hours as this type of milk is very rich. milk in immunoglobulins and bacteria of the intestinal flora '.
In this way, through skin-to-skin and breastfeeding, the mother of a premature child feels that it is part of the medicine that is treating her child.
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